Cryptococcal meningitis following a thrombotic microangiopathy in an unrelated donor bone marrow transplant recipient.

Abstract:

:In patients undergoing bone marrow transplantation cryptococcosis is rarely encountered. We report a fatal case of Cryptococcus meningitis in a 12-year-old girl with acute lymphoblastic leukemia (ALL) in second remission who had a transplant from a human leukocyte antigen (HLA)-identical unrelated bone marrow donor. The conditioning regimen was thiotepa, cyclophosphamide, and total body irradiation (TBI); graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporin A, methotrexate, and antilymphocyte globulin (ALG). The patient experienced stage III GVHD responsive to high-dose corticosteroids. On day +54 a thrombotic microangiopathy occurred. On day +64 neurological status worsened; a brain computed tomographic (CT) scan showed hyperdense lesions suggesting fungal infection. Detection of cryptococcal antigen by latex agglutination was positive but India ink stain and culture were negative. Despite treatment with amphotericin B, 5-flucytosine, and granulocyte-macrophage colony-stimulating factor, the patient died 13 days after the diagnosis.

journal_name

Pediatr Hematol Oncol

authors

Miniero R,Nesi F,Vai S,De Intinis G,Papalia F,Targhetta R,Busca A,Vassallo E,Giacchino M

doi

10.3109/08880019709028778

subject

Has Abstract

pub_date

1997-09-01 00:00:00

pages

469-74

issue

5

eissn

0888-0018

issn

1521-0669

journal_volume

14

pub_type

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